| NPI | 1174109615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NJ 25MA12367700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA12367700) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-09-13 |